Provider Demographics
NPI:1114190352
Name:SCHOOL DISTRICT OF LAONA
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF LAONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-674-2143
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:LAONA
Mailing Address - State:WI
Mailing Address - Zip Code:54541-0100
Mailing Address - Country:US
Mailing Address - Phone:715-674-2143
Mailing Address - Fax:715-674-5904
Practice Address - Street 1:5216 FOREST AV
Practice Address - Street 2:
Practice Address - City:LAONA
Practice Address - State:WI
Practice Address - Zip Code:54541-0100
Practice Address - Country:US
Practice Address - Phone:715-674-2143
Practice Address - Fax:715-674-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44240400Medicaid